Why Do Some Ill People Want to Die?
WebMD News Archive
This loss of community appears to be a core feature of loss of
self. The finding doesn't settle the debate over whether doctor-assisted
suicide is right or wrong. It does something far more useful: It points to ways
that end-of-life care can be improved.
Robert A. Pearlman, MD, MPH, is professor of medicine at the
University of Washington and director of the Northwest Ethics Center for
Veterans Health Care, in Seattle. He is co-author of an editorial appearing
alongside the Lavery team's study in the medical journal The Lancet.
Pearlman says end-of-life care needs to address the issues of
loss of self and loss of community. He argues that healthcare research should
look for ways to help people deal with the isolation or loss of meaning that
comes from the loss of community that patients described to Lavery. Pearlman
also endorses Lavery's approach of listening to patients instead of asking
"Patients can be our teachers, as opposed to assuming we
understand their experiences," he tells WebMD. "There is the need for
healthcare providers and families to hear about patient experiences so they can
better address them and do a better job in promoting quality of life and
quality of dying."
Lavery points to two patients. One, a man at death's door, was
a community activist who remained involved from his hospital bed. He strongly
believed that doctor-assisted suicide should be legal, but did not want it for
himself. Another man was far less ill, but was rejected by his family when he
told them he was gay and was rejected by his lover when he told him he had HIV.
This man wanted very much to die.
"Caregivers must be attentive not only to the physical side
of illness but also to the meaning of what dignity really is," Lavery says.
"Dignity has to do with integrity of the self. You cannot expect that
people will lie isolated in a bed and not experience profound changes in how
they perceive themselves. As a response to terminal illness we should ensure
highest quality not only of technical care for symptoms, but for community. We
should provide a role for patients and keep this role for them until they